Association of household net worth with healthcare utilization in 90-day window after radical cystectomy using real-world data.

Abstract

444 Background: Radical cystectomy (RC) remains the gold standard for muscle invasive bladder cancer yet confers significant healthcare costs. Prior work on the impact of costs commonly relied on comparisons by insurance status (yes/no) and income, a partial proxy for net worth, ie one’s net economic standing or value of financial assets minus liabilities. Few have examined the relationship between net worth and encounter type. Methods: We identified commercially insured Black, White, Asian, and Hispanic patients who underwent radical cystectomy between January 1, 2007 to April 10, 2021 in The OptumLabs Data Warehouse, a longitudinal, real-world data asset with de-identified administrative claims and electronic health record data. Demographics and costs included household net worth, health plan costs, out of pocket costs, and total healthcare costs accrued from index admission to 90 days after. Multivariable logistic regression models were generated for each encounter type [acute inpatient, emergency department (ED), outpatient, and office visit]. Odds ratios (OR) are presented with 95% confidence intervals (CI) and p-values. A p value of <0.05 was deemed statistically significant. Results: The study cohort was comprised of 141,903 patients (2.4% were Black, 11.4% Hispanic, and 8.1% Asian). Household net worth categories were near evenly distributed amongst the study cohort. Acute inpatient encounters harbored the greatest health plan (mean $24,642.80, SD $57,218.41) and out of pocket costs (mean $1,428.24, SD $2108). Office visits conferred the lowest health plan costs (mean $1,126.78, SD $4,119.12) while ED visits had the lowest out of pocket costs (mean $181.88; SD $399.65). Black patients harbored increased odds of an acute inpatient encounter (HR 1.22, 95% CI 1.16-1.29) and ED encounter (HR 1.20, 95% CI 1.14-1.27) while Asian (HR 0.76, 95% CI 0.69-0.85, p<0.001) and Hispanic (HR 0.74, 95% CI 0.69-0.78, p<0.001) patients had lower odds of an outpatient encounter. Increasing household net worth was associated with decreasing odds of acute inpatient or ED encounters, and greater odds of an office visit. Conclusions: Our study is the largest cohort of commercially insured patients to examine variations in healthcare utilization by net worth in the 90 days after radical cystectomy. Those with lower net worth harbored greater risk of an acute inpatient encounter (and higher medical costs) while those with the greater net worth had greater odds of office visits (and lower costs). Greater financial flexibility (i.e., net worth) continues to confer differences in healthcare utilization (and lower healthcare costs), even within a commercially insured population. Household net worth provides a more comprehensive assessment of patients’ financial flexibility than income alone and functions as proxy for healthcare access and privilege that could not be directly measured.